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Long-term care has increasingly been subject to mechanisms to manage care in order to control costs and meet institutional demands for cost containment and efficiency. Fundamentally, managed care seeks to limit access to services that are deemed costly, intensive and/or long-term. However, long-term care by definition requires continuity of care across diverse service sectors. In order for managed long-term care to work, these sectors must be well integrated and able to share information about client needs. In this paper we examine the growth of managed care in the long-term care sector. We have collected data from long-term care agencies in adjoining counties (one urban, the other suburban) at three points in time (1997, 1999, and 2001) and are in a position to describe changes in the types of agencies providing long-term care, and the degree of managed care penetration in our sample. We also collected data on administrators’ evaluations of managed care, and their perceptions of the effect of managed care on services and service system integration. We conclude by discussing the future of long-term care.

This qualitative study aims to explore the experiences of Taiwan’s community-based long-term care service stations.

Semi-structured interviews were conducted with eight managers selected from stations located in the counties with the highest proportion of elderly people.

The results are as follows: the main services offered by the stations include health promotion activities, congregate meal programs, respite care and making house calls; government subsidies constitute a major proportion of the service stations’ funds, followed by user payments and external donations; the adversities encountered include frequent policy revisions, the dwellers’ reluctance to participate in the activities, manpower shortages and subpar service quality; and the effects of the stations on the community include achieving aging in place, providing more options for life after retirement, mitigating caregivers’ burden, expanding the elderly’s social networks and strengthening their health literacy.

The results of this research can understand the benefits and difficulties of Tier C service centers in Taiwan. Also, the practical experiences provide some suggestions for policies and training. Future studies can focus on establishing systematized training programs and standardizing the service personnel’s competence.

Demand for long-term care services increases with population aging. This study aims to develop a conceptual model of elderly customers’ health-care experiences to explore the antecedents, mechanisms and outcomes of social participation in long-term care service organizations.

Using a two-phase data collection approach, this study collects data from 238 elderly customers in a long-term care service organization. The final data are analyzed through structural equation modeling.

The results show that care management efforts (i.e. customer education, perceived organization support, role modeling, perceived other customer support and diversity of activity) influence elderly customers’ psychological states (i.e. self-efficacy and sense of community), leading to increased social participation. In addition, high levels of social participation evoke positive service satisfaction and quality of life, both of which alleviate switching intention.

This study is one of the first conclusive service studies focused on the role of elderly customers’ social participation in their long-term care experience. The findings contribute to health-care service marketing and transformative service research, and expand understanding of elderly customers’ health-care experience, especially in long-term care service settings.

Policy requires that those with complex long‐term needs be offered case management, a primary care led service dependent on local health and social care resources. This paper explores the arrangement of networks for a number of case management services, using data from a postal questionnaire.

Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.

Design/methodology/approach: Care managers (CMs)/social workers (SWs) (N = 124) participated in a comparative vignette study including Japan, South Korea, and Sweden. Systems theory was used.

Findings: Japanese CMs/SWs clearly describe their efforts to create networks in a relational way between formal and informal actors in the community. South Korean CMs/SWs balance between suggesting interventions to support daily life at home or a move to a nursing home, often acknowledging the family as the main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting the older adult and the interventions offered, and families primarily give social support. Regarding self-determination, the Japanese priority is for CMs/SWs to harmonize within the family and the community. South Korean CMs/SWs express ambivalent attitudes to older adults’ capability for self-determination in the intersection between formal and family care. Swedish CMs/SWs adhere to the older adult’s self-determination, while acknowledging the role of the family in persuading the older adult to accept interventions. The results suggest emerging defamilialization in South Korea, while tendencies to refamilialization are noticed in Japan and Sweden, albeit in different ways.

Research limitations/implications: In translation, nuances may be lost. A focus on changing families shows that country-specific details in care services have been reduced. For future research, perspectives of “care” need to be studied on different levels.

Originality/value: Using one vignette in three countries with different welfare regimes, discussing changing views on families’, communities’ and societal caregiving is unique. This captures changes in policy, influencing re- and defamilialization.

There are clear theoretical, policy and practice tensions in conceptualising social or long-term care as a “right”: an enforceable choice. The purpose of this article is to address the following questions: Do disabled and older citizens have the right to long-term care? What do these rights look like under different care regimes? Do citizens have the right or duty to *provide* long-term care? It is already known that both formal and informal care across all welfare contexts is mainly provided by women and that this has serious implications for gender equality.

In this article, the author takes a conceptual approach to examining the comparative evidence from developed welfare states with formal long-term care provision and the different models of care, to challenge feminist care theory from the perspective of those living in care poverty (i.e. with insufficient access to long-term care and support to meet their citizenship rights).

Drawing on her own comparative research on models of long-term and “personalised” care, the author finds that different models of state provision and different models of personalised care provide differential citizenship outcomes for carers and those needing care. The findings indicate that well-governed personalised long-term care provides the best outcomes in terms of balancing potentially conflicting citizenship claims and addressing care poverty.

The author develops new approaches to care theory based on citizenship and care poverty that have not been published elsewhere, drawing on models that she developed herself.

The demand for long-term home care services has been increasing in Taiwan due to the significant growth of the older population. In order to understand the crucial roles that language and communication play in providing better long-term home care services in Taiwan, this study aims to adopt a gerontological sociolinguistic perspective to investigate how professional care workers communicate with older people in this context.

Interviews were conducted with 58 long-term home care workers to identify their communication accommodation strategies for older people, considering their health conditions (dementia), personalities (grumpiness), living status (loneliness) and general principles of long-term home care communication.

The study's findings provide practical insights for long-term home care workers to enhance their communication skills while interacting with older people.

The results could contribute to improving the quality of care services provided to older people and address their specific communication needs.

To the best of the author’s knowledge, this paper is the first attempt to identify contextually specific communication accommodations to older people in existing literature of gerontological sociolinguistics that addresses language, communication and older age. The salience of the findings in this study can be further enhanced if they were applied in the development of training programs for future Taiwanese long-term home care workers.

Despite the current focus on demand-based care, little is known about what clients consider important when they have a request for formal long-term care services. The paper aims to discuss this issue.

Questions about the access process to care services were added to the “Senior Barometer”, a Dutch web-based questionnaire that assesses the opinion of older people about different aspects in life. The questionnaire surveyed both people who already requested care services (“users”), and people that did not (“future clients”).

The results show a significant difference in what people expect to be the first step from what users actually did, when requesting formal care services. In addition, there was a significant difference on how “users” and “future clients” rated several access service aspects.

The results give valuable information on how both “users” and “future clients” value the access process. The findings also provide valuable input for organizations providing long-term care for older clients about the important issues that have to be considered when organizing the access process.

This study shows what older people in the Netherlands find important during the access process to care and this has not been explored before. The difference between what “users” and “future clients” find of importance in the care access process suggests that it is difficult for people to foresee what will be important once the need for care arrives, or where they will turn to with a request for care services.

Spain departed from the Southern European tradition of residual long-term care services with the 2006 reform. The paper aims to present the main traits of the reform and its implementation, explores the reasons that may explain why the reform happened and to which extent and why it fell short of expectations.

The article draws on available literature on the reform and on administrative data to present a complex and nuanced view of the reform process and its limits.

The reform was actually a measure to enhance and rationalize a preexisting process of social care services development, rather than the creation of a completely new care system. A rapid increase in female labor market participation since the 1990s and the looming demands of a late baby-boom and the subsequent fertility crash appear to be two key factors that explain both the previous development and its bolstering by the reform. The budgetary constraints of the Great Recession and governance problems, linked to a complex and sometimes dysfunctional multilevel governance arrangement, help to understand why the reform bogged down. Nevertheless, the overall balance is more nuanced, and significantly more services are provided 12 years after the reform.

While many assessments of the reform have been negative, putting it into a larger context of social care development, the 2006 Dependency Act has contributed to a significant increase in expenditure and coverage. The impact of budgetary restrictions has been important, but other factors, such as governance arrangements, may explain more of the problems of the implementation.